During the alpha phase we made a prototype of a “planner” for Type 2 Diabetes. It’s a product of our research into long term conditions, and demonstrates our vision of connecting people to information and services across the health and care system.

In this post I’m going to talk about the planner and what it embodies in terms of our research, and design so far. I’m going to look at the implications of “visionary” prototypes like this one, and how they relate to the work we’re doing at beta.nhs.uk.

Right then, here we go.

We researched type 2 diabetes and mild to moderate anxiety and depression. Studying specific conditions can give us insight and empathy.

Studying two long term conditions can help us spot common patterns. These patterns can help us create solutions for managing long term conditions in general. Common patterns will help us scale, as we can’t study every known condition.

The planner

Information area


The planner information area

A primary need is to know about your latest test results and your current medication. In the case of type 2 diabetes, that’s likely to be blood sugar tests and Metformin.


Expanded test results area showing latest blood test result

An expanded test results area shows your recent results. It also lists any actions discussed, based on this result. Links allow you to view older tests, and learn what the tests mean.

Things to do now


Planner 'Things to do now' section

Next up are things are things you need to do, such as booking regular appointments. Specific guidance, such as “you shouldn’t drive for 2 hours after the eye check”, is displayed before the “book now” call to action.


Blood sugar test call to action with expanded information

Progressive disclosure marked “show more” lets you find out a bit more about the reasons for these appointments.

Appointments and reminders


Planner 'Appointments and reminders section'

Booked appointments, repeat prescription pickups, are all shown in this area.


Expanded blood sugar test appointment

Booked appointments show a summary, along with useful controls: calendar links; printing; controlling reminders; rescheduling and cancelling. Again, progressive disclosure allows you to find out more about the reason for the appointment.

From “just coping” to understanding and managing

What’s the point of a planner like this? How is it meeting users’ needs?

Being diagnosed with a long term condition can be a traumatic experience, and there’s a lot to take on board simply in terms of coping. Remembering to take medication. Picking up more medication. Remembering to book regular appointments. Making sure you don’t miss those appointments.

During our research, we mapped out the journey a person takes from feeling that something’s wrong and seeking help, through to life after diagnosis. Having an understanding of, and empathy with, that experience allows us to design service propositions that map closely to what people need, when they need it.


Patient experience map

Martin’s written about researching and mapping the patient experience here.

The planner prototype is based around someone recently diagnosed with type 2 diabetes. At this stage, a routine of appointments and medication needs to be established and stuck to. On the experience map, this is just after the point of diagnosis, beginning the phases of “learning” and “treatment”:

“What does this mean for me, and what do I have to do?”

We built the planner prototype as a way to help people:

  1. cope with their condition, giving clear instructions on what needs to be done
  2. learn more about that condition, by offering routes to find out more

During our research, one thing that came up again and again was the feeling of being engulfed by a tidal wave of information and tasks, having too much thrown at you too soon. The planner allows you to get to grips with the basics first, while giving you routes to learn more.

For example:


Animation of a user journey through the planner’s Metformin area

You can look at your prescribed Metformin medication.

By default this displays information about how and when to take it, side effects to watch out for and so on. This information reflects a need to perform an important action (taking your meds).

By using a “show more” control, we can display a short snippet of information about Metformin – the basics about what it does and how it does it.

Showing the basics, using progressive disclosure, helps outline the most important things you need to know. From here, there’s an opportunity to go on and find out more about the drug at Diabetes UK.

This tiered approach might seem self evident. But you can see how the interface works in tandem with our experience map. Rather than flooding a user with lots of information immediately, we present them with opportunities to increase knowledge and understanding of their condition. We’re aiming for a learning curve, rather than something more akin to a cliff face. Precedence at this early stage is given to coping — learning routines and forming habits.

What did we learn from users?

The planner was shown to 11 users over 2 research sessions. They had all been diagnosed with type 2 diabetes within the past 2 years.

People grasped the task-based nature of the interface, and responded well to opportunities to drill into more detail.

We had a positive response in user research:

  • When is it going to be up? — P45
  • It’s good. It has a goal or a target to reduce it. This bit is helpful as well. Suggestions. — P45
  • This would be a very good system, yes, very good. — P47
  • Oh look see. What you can do now. This is brilliant. — P47
  • Their information becomes my information. — P48

A large amount of enthusiasm was probably based on the fact the planner envisages a landscape in which the the health and care system communicates seamlessly. Many of the problems people face are around navigating through the various parts of the health service, none of which seem to talk to each other.

Service design through prototyping

Prototypes imagine a possible future service. Underlying systemic processes and objects are implied by prototypes — and that’s part of their usefulness.

In the instance of our planner, you can see the implications. It’s not necessarily an online application — the planner is just one single “surface” of a service. There could be multiple surfaces. For example you could imagine planner elements as a series of SMS messages or emails. Or a similar interface could be used by a healthcare professional talking to a patient.

To actually produce a service visualised in a prototype can be far from trivial. But with solid research we can be more sure we’re working towards the right service.

A service such as the planner requires joined up systems across health that can exchange information. It requires canonical and well maintained sources of data. It shows a health and care service working in a cohesive way to connect patients to the information and services they need. It shows one interface to services that utilise systems (both existent and not) in the service of the user.

The interface is mapped to the user’s needs in the context of their journey — what we’re specifically not doing is gathering and exposing all available systems in one place and leaving it to users to work out what to do next. That’s the tail wagging the dog, and another way that people can be flooded with information and too many options all at once.

Patients shouldn’t have to understand the way the NHS is organised to get care. We’re here to help join the dots. Interfaces like the planner are one way we could help free up healthcare professionals from having to help co-ordinate navigation of the system.

Where next?

While the planner was a success in the context of a single condition, we know that living with multiple conditions is a reality for many. How could an interface like this cope with the added complexities?

Users’ experience of living with a condition will change, and it will change differently for different people and different conditions. Some will learn to cope with a condition, and that will be enough. Others will devour information and become expert in their conditions. We need to think about how the planner could evolve and respond in tandem with individual patient journeys.

In conclusion

A landscape of integrated systems, with simple and easy access to data seems a long way off.

But what we can glean from a user-focussed and research-led approach, is the directions we head in and hypotheses we put forward are grounded solutions that  serve real user needs.

Content-based pages at alpha.nhs.uk and beta.nhs.uk represent one end of a scale of context: we’re concentrating on clear, action focused content, applicable to a broad and unidentified audience.

The planner prototype represents the other end of the scale: contextual, personalised content and services.

As we progress, we’ll be creating more prototypes (and building real products) that meet users’ needs through a full spectrum of context — from generalised to highly specific. Stay tuned!

5 comments

  1. Comment from James Burleigh

    Do you need any volunteers to test the Diabetes app.?

    Reply
    • Comment from Mat Johnson

      Hi James.

      At the moment the diabetes planner is a “flat” prototype, and we’re not looking for testers as such. With prototypes like this, we’re usually in a lab setting, one on one.

      On the other hand, if you want to feed back on what’s there, please do – either on this blog, or email alphafeedback@digital.nhs.uk

      Reply
  2. Comment from Victoria

    This prototype looks great but I’m not clear from the blog how it goes from prototype to reality, or in what timeframe.

    Reply
    • Comment from Mat Johnson

      Hi Victoria.
      The diabetes planner was designed in our exploratory “alpha” phase.
      Our current focus in “beta” is the transformation of NHS Choices and the development of digital service standards.
      These projects, along with the partnerships we’re building with digital teams across the NHS, will help us to put the building blocks in place to deliver personalised services like this, in the future.

      Reply
  3. Comment from Danika Barber

    this looks great – my Dad has been living with type 2 diabetes for 30 years now, and as he got older he found it harder and harder to manage his condition. I showed my Mum how she could download a digital app onto her ipad to monitor his sugar levels and insulin dose, and his long term HBA1C has improved dramatically – to the shock of his healthcare professionals – all from keeping better track and having reminders for taking his insulin. An app like this would really help carers as well as those with the condition, as my Mum’s life seems to be consumed by picking up medicine, appointments, tablets etc for Dad – this would make it much simpler.

    Reply

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